Excellent disease eradication by myeloablative therapy and stem-cell transplantation in patients with acute myelogenous leukemia

Between February 1982 and 1999, 118 consecutive patients (65 male, 53 femal e) with acute myelogenous leukemia (AML), with a median age of 35 years (ra nge 17-56 years), received stem-cell grafts from a human leukocyte antigen- identical sibling (n =71), one-antigen-mismatched family member (n=2), matc hed unrelated donor (n=15), one-antigen-mismatched unrelated donor (n = 4) or an autologous (n = 26) graft. At the time of transplant, 56 patients wer e in the first complete remission (CR), 27 in the second CR, 6 in untreated relapse, 17 in primary refractory, and 12 in refractory relapse. The Frenc h-American-British classification (FAB) subtypes were as follows: M1 (n=25) , M2 (n = 28), M3 (n=11), M4 (n = 32), M5 (n = 16), M6 (n=6). For condition ing, most patients underwent total body irradiation-containing regimens. As of 28 February, 1999, probability of leukemia-free survival (LFS) is 58% f or patients after related and 45% after unrelated stem-cell transplantation (SCT). The probability of LFS is 70% for patients given allogeneic transpl ants in the first CR compared with 33% for those beyond the first CR at SCT . In autologous stem-cell graft recipients, the probability of LFS is 37%. Transplant-related mortality was 28% after related, 20% after unrelated, an d 4% after autologous SCT. Probability of relapse for patients given relate d-donor stem-cell grafts in the first CR and beyond the first CR is 30% and 67%, 55% after unrelated and 63% after autologous stem-cell grafting. Thus , myeloablative therapy followed by allogeneic stem-cell infusion has a hig h curative potential for patients with AML in remission and offers substant ial benefits to patients in advanced disease.